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Insurance Claims Specialist
2 months ago
GetixHealth is seeking a highly skilled Insurance Team Lead to join our team in Tacoma, WA.
Job Summary:We are looking for a motivated and detail-oriented professional to lead our insurance team. The successful candidate will be responsible for reviewing accounts placed as self-pay to determine if insurance coverage exists, analyzing unpaid claims, and contacting insurance carriers to obtain status on claims and ultimately payment.
Key Responsibilities:- Review accounts placed as self-pay to determine if insurance coverage exists.
- Analyze unpaid claims and determine reason for them to have not been adjudicated.
- Contact insurance carriers to obtain status on claims and ultimately payment.
- Utilize online tools to research insurance claims when available.
- Obtain supporting documentation to submit to insurance carriers.
- Submit appeals in proper format when appropriate.
- Review, interpret, and apply contractual terms.
- Contact patients/guarantors to facilitate and expedite processing of their claims when needed.
- Assist with other duties related to special projects.
- Perform job duties in accordance with the organization's information security policies.
- 7+ years' experience in a facility setting performing insurance follow-up/denials management.
- Knowledge of UB04/CMS 1450 and CMS 1500 claim forms, EDI, HCPCS, ICD-9/ICD-10, CPT, DRGs, and ability to interpret an Explanation of Benefits.
- Complete working knowledge of billing instructions and procedures for each payer source according to regulations and guidelines.
- Knowledge of Commercial, Governmental, and third-party denials and appeals processes.
- Knowledge of billing systems.
- Must have effective organizational skills and a high attention to detail.
- Medical terminology required.
- Must demonstrate the ability to adapt to change, maintain professionalism in challenging situations, and work in a business professional environment.
The position requires the dexterity to operate office equipment such as a personal computer, keyboard, mouse, and telephone. Occasional lifting may be required up to 25 lbs. Must be able to sit for extended periods of time with frequent bending and stooping.
GetixHealth is an equal employment opportunity employer.